Skip to main content

Advertisement

SpringerLink
Log in

Accuracy and Underestimation of Malignancy of Breast Core Needle Biopsy: the Florence Experience of Over 4000 Consecutive Biopsies

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Breast core needle biopsy (CNB) is used for sampling breast lesions in both the screening and diagnostic context. We present the accuracy of breast CNB from a consecutive series of 4035 core biopsies, using methods that minimise selection and verification bias. We calculate accuracy and underestimation of malignancy for both automated (14G) and directional vacuum-assisted (11G) CNB performed under stereotactic or sonographic guidance. Overall sensitivity of CNB is 94.2% (92.9–95.5%) and specificity is 88.1% (86.6–89.6%), positive and negative predictive values are 84.8% (82.9–86.7%) and 95.6% (94.6–96.6%), respectively. In sampling microcalcification, the overall underestimation of malignancy is 26.6% (22.9–30.3%): underestimation is significantly higher for automated CB relative to VAB (χ2 (df = 1) = 8.90 , P = 0.002), the absolute difference in underestimation being 14% (5–23%); sensitivity is higher for VAB than automated CB (χ2 (df = 1) = 3.28, P = 0.06) but specificity is significantly higher for automated CB (14G) relative to VAB (11G) (χ2 (df = 1) = 6.37, P = 0.01), and the overall accuracy of the two methods is similar. Sensitivity of CNB improved with experience (over time and in relation to caseload). Accuracy was not substantially affected by lesion palpability or image-guidance method, and was similar for both masses and calcification but lower for lesions depicted as distortions on mammography. Inadequacy was very low and decreased with greater operator caseload, and was not associated with core gauge or image-guidance method. False negatives occurred in 4.4% (3.4–5.4%) of cases, and where core histology was benign but discordant with (suspicious) imaging and/or clinical findings the likelihood of malignancy was 33.1% (18.5–47.7%), emphasising the importance of correlating all test information in breast diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parker SH, Burbank F, Jackman RJ et al (1994) Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 193:359–364

    PubMed  CAS  Google Scholar 

  2. Parker SH, Jobe WE, Dennis MA et al (1993) US-guided automated large-core breast biopsy. Radiology 187:507–511

    PubMed  CAS  Google Scholar 

  3. Parker SH, Lovin JD, Jobe WE et al (1991) Non-palpable breast lesions: stereotactic automated large-core biopsies. Radiology 180:403–407

    PubMed  CAS  Google Scholar 

  4. Parker SH, Lovin JD, Jobe WE et al (1990) Stereotactic breast biopsy with a biopsy gun. Radiology 176:741–747

    PubMed  CAS  Google Scholar 

  5. Liberman L, Dershaw DD, Rosen PP et al (1995) Stereotaxic core biopsy of impalpable spiculated breast masses. AJR Am J Roentgenol 165:551–554

    PubMed  CAS  Google Scholar 

  6. Liberman L, La Trenta LR, Van Zee KJ et al (1997) Stereotactic core biopsy of calcifications highly suggestive of malignancy. Radiology 203:673–677

    PubMed  CAS  Google Scholar 

  7. Jackman RJ, Nowels KW, Rodriguez-Soto J et al (1999) Stereotactic automated large-core needle biopsy of non-palpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210:799–805

    PubMed  CAS  Google Scholar 

  8. Burbank F (1997) Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with a directional, vacuum-assisted biopsy instrument. Radiology 202:843–847

    PubMed  CAS  Google Scholar 

  9. Burbank F (1997) Stereotactic breast biopsy: comparison of 14- and 11-gauge Mammotome probe performance and complication rates. Am Surg 63:988–995

    PubMed  CAS  Google Scholar 

  10. Meyer JE, Smith DN, Lester SC et al (1999) Large-core needle biopsy of nonpalpable breast lesions. JAMA 281:1638–1641

    Article  PubMed  CAS  Google Scholar 

  11. Stolier AJ (1997) Stereotactic breast biopsy: a surgical series. J Am Coll Surg 185:224–228

    PubMed  CAS  Google Scholar 

  12. Rao A, Parker S, Ratzer E, Stephens J, Fenoglio M (2002) Atypical ductal hyperplasia of the breast diagnosed by 11-gauge directional vacuum-assisted biopsy. Am J Surg 184:534–537

    Article  PubMed  Google Scholar 

  13. Lin PH, Clyde JC, Bates DM et al (1998) Accuracy of stereotactic core-needle breast biopsy in atypical ductal hyperplasia. Am J Surg 175:380–382

    Article  PubMed  CAS  Google Scholar 

  14. Verkooijen HM (2002) Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicentre prospective study with 95% surgical confirmation. Int J Cancer 99:853–859

    Article  PubMed  CAS  Google Scholar 

  15. Brenner RJ, Bassett LW, Fajardo LL et al (2001) Stereotactic core-needle breast biopsy: a multi-institutional prospective trial. Radiology 218:866–872

    PubMed  CAS  Google Scholar 

  16. White RR, Halperin TJ, Olson JA Jr, Soo MS, Bentley RC, Seigler HF (2001) Impact of core-needle breast biopsy on the surgical management of mammographic abnormalities. Ann Surg 233:769–777

    Article  PubMed  CAS  Google Scholar 

  17. Houssami N, Irwig L (1998) Likelihood ratios for clinical examination, mammography, ultrasound and fine needle biopsy in women with breast problems. Breast 7:85–89

    Article  Google Scholar 

  18. Fuhrman GM, Cederbom GJ, Bolton JS et al (1998) Image-guided core-needle biopsy is an accurate technique to evaluate patients with non-palpable imaging abnormalities. Ann Surg 227:932–939

    Article  PubMed  CAS  Google Scholar 

  19. Houssami N, Ciatto S, Ambrogetti D et al (2005) Florence–Sydney Breast Biopsy Study: sensitivity of ultrasound-guided versus freehand fine needle biopsy of palpable breast cancer. Breast Cancer Res Treat 89:55–59

    Article  PubMed  CAS  Google Scholar 

  20. Perry N, Broeders M, de Wolf C, Tornberg S (eds) (2001) European Guidelines for quality assurance in mammography screening, 3rd edn. Europe against cancer. European Commission, Luxembourg

  21. Gisvold JJ, Goellner JR, CS Grant et al (1994) Breast biopsy: a comparative study of stereotaxically guided core and excisional techniques. AJR Am J Roentgenol 162:815–820

    PubMed  CAS  Google Scholar 

  22. Liberman L (2000) Clinical management issues in percutaneous core breast biopsy. Radiol Clin N Am 38:791–807

    Article  PubMed  CAS  Google Scholar 

  23. Darling MLR, Smith DN, Lester SC et al (2000) Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol 175:1341–1346

    PubMed  CAS  Google Scholar 

  24. Jackman RJ, Nowels KW, Shepard MJ, Finkelstein SI, Marzoni FA (1994) Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology 193:91–95

    PubMed  CAS  Google Scholar 

  25. Nori J, Cariti G, Masi A et al (2001) Histologic microbiopsy with 14G needle in the diagnosis of breast lesions. Experience with 1000 cases. Radiol Med (Torino) 101:31–38

    CAS  Google Scholar 

Download references

Acknowledgement

Dr Houssami is partly funded by a National Health and Medical Research Council (NHMRC) program grant to the Screening & Test Evaluation Program.

Author information

Authors and Affiliations

  1. Centro per lo Studio e la Prevenzione Oncologica (CSPO), Florence, Italy

    Stefano Ciatto, Daniela Ambrogetti, Rita Bonardi, Beniamino Brancato, Sandra Catarzi & Gabriella G. Risso

  2. Screening and Test Evaluation Program (STEP), School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia

    Nehmat Houssami

  3. Department of pathology, Florence University, Florence, Italy

    Simonetta Bianchi

Authors
  1. Stefano Ciatto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nehmat Houssami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Ambrogetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simonetta Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rita Bonardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Beniamino Brancato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sandra Catarzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gabriella G. Risso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nehmat Houssami.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ciatto, S., Houssami, N., Ambrogetti, D. et al. Accuracy and Underestimation of Malignancy of Breast Core Needle Biopsy: the Florence Experience of Over 4000 Consecutive Biopsies. Breast Cancer Res Treat 101, 291–297 (2007). https://doi.org/10.1007/s10549-006-9289-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-006-9289-6

Keywords

Search

Navigation